CHANGES TO STARK LAW, NEW ADVANCE CARE PAYMENTS INCLUDED IN 2016 PHYSICIAN

FEE SCHEDULE -

The Centers for Medicare & Medicaid Services (CMS) recently published a final rule (Final Rule) regarding physician payment policies and rates in the Medicare Physician Fee Schedule. Included among the finalized policies were a number of notable revisions and additions to the physician self-referral law (Stark Law). Also included were modifications to “incident to” billing rules, the creation of separate payments to physicians for advance care planning, and modifications to the Medicare Shared Savings Program (MSSP). The Final Rule took effect January 1, 2016 (with one exception noted below). Highlights of the Final Rule are described below.

Stark Law -

The Stark Law prohibits a physician from making referrals for designated health services (DHS) to an entity with which the physician (or an immediate family member) has a financial relationship unless the relationship satisfies an exception to the general prohibition. The Final Rule creates new Stark Law exceptions and makes several regulatory updates and clarifications to existing exceptions.